Hiking Through Residency - Mount Lemmon Loop Trail

Today was the first of many hikes that I will take while in Tucson.  Sarah (my co-resident) and I headed up to Mount Lemmon for a hike.  It was a nice way to get out of the heat.

This may have been a little bit of an ambitious first hike, but we survived :)

Trail stats:

Distance:  8.6 miles

Trailhead elevation:  9100 feet

Elevation loss/gain:  2100 feet

The loop of course started out with the easier part, heading down hill.  It was cool atop Mt. Lemmon today.  I was happy to be wearing pants and a long sleeve shirt.  At the beginning of the hike, the mountain is covered with pine trees and wildflowers.  

It rained on us some in the beginning of the hike - HUGE raindrops!  Well...actually not raindrops.  Turned out it was HAIL.  That's right, I got hailed on in Tucson in the middle of August.

Storm Clouds

Proof - HAIL!

After hiking down 2100 feet the vegetation changed and became more desert like in nature.  The sun came out and the sweating began.  eww....  At this point, about 6 miles in I was still feeling pretty good.

Then the ascent began.  Let's just say it was much quicker than the descent had been.  My right calf was burning and I was sucking wind and could feel the elevation.  We had approximately 2 miles of switch backs to the top where we had originally started.  It started to rain, but it felt good - cooled me off some.  The view from this side of the loop trail was GORGEOUS!!!  It was amazing and completely worth it.  

Of course the picture doesn't do the view justice!

A horrible picture of us on our hike - nice.

By the time we reached the top I was exhausted.  Poor Sarah who drove home, watched my head bob like a bobble head in the seat next to her, trying to stay awake.  It's 8pm now - my legs still feel like spaghetti.  I think I'll be in bed and passed out by 8:30pm.  It ended up being a great hike, but probably a little much for my first hike in a while. 

Bugs on the trail:

swarms of ladybugs sitting on these plants for some reason?!

close up of a bunch!

Purple/blue beetle!!!

immature

It's funny, how I waited 4 years to finally have some responsibility.  To finally be able to write a note that didn't have to be rewritten by someone else, to finally be able to write for fluids or antibiotics and the patient actually get the fluids or medicine.  4 years!  It seemed so long, like the time would never come.

Well...the time has finally arrived.  During this last month working in the Emergency Department, I have given patients more morphine and dilaudid, than I ever imagined.  Ok, maybe not ever imagined, but A LOT.  It comes with the territory, the sickest, the ones in the most pain, the ones without insurance or primary care -they are the ones that end up in the Emergency Department.

The rotation was great - I got to get my hands dirty a do a few procedures.  I learned to think like an ER doc and got to know Sief's colleagues better.  It started to feel like a home away from home.  I was comfortable in the department and still am - which is good, because I'll be admitting a lot of patients from there soon enough.

The most humbling moment of my career happened behind those Emergency Department doors.  A moment that made me for the first time in a long time feel extremely young and unprepared.  I had a young patient, less than 50, who walked into the emergency department, but will not walk out.  I am not going to give details, but I left that night thinking, "I'm not mature enough or old enough to handle this." The weight of responsibility that is my profession finally hit.  Daily, people lay their lives in my hands, let me in on their deepest secrets, expose their most personal body parts, all because I wear a white coat and have M.D. after my name.  That's a big deal.  A responsibility I never took lightly, but also one I am unsure I will ever be able to fully grasp.

I need bigger, broader shoulders to carry certain memories with me.  I now know, some patient's will never leave my side.  They will not always be on my mind, but they will be living in my memories, right at the surface.  Time to time I will recall those patients, will reflect on the situation and remember.  Learn from those difficult patients, learn from the surprises, and learn from those who were saved and those that could not be.
As physicians we do not have al the answers.  We cannot save everyone.  There are higher powers and diseases too strong for modern medicine.

My job is to never be mature enough to handle certain obstacles that will appear in my career.  My job is to learn and grow, to embrace the opportunity to learn and to reflect.  I have sacrificed for my patients and some of my patients have and will make sacrifices for my continuing education.  I am privileged to have the honor of working in the field that I do.  Now it is my duty and joy to do the best that I can.

In love

Ok, so I fell in love yesterday with Tamales and not just any Tamales, but the best Tamales I have ever tasted!!!  :)  It was a recommendation from a native Tucsonian.

The Tucson Tamale Company.  I guess from the name you can figure out what they make.  I went yesterday during my hour lunch break - it was a fast lunch and I ate waaayyyy too fast, but...I'm planning to stop by today to get some tamales to go before work starts!

Here's what I tried yesterday:

Green Corn Tamale:  Fresh Corn Masa, Roasted Green Chile, Cheese

Madison: Black beans, fresh corn, red peppers, spices, cheese in red pepper masa

Incredible salsa accompanies the tamale to pour over the top.  I only tried the mild, apparently the medium salsa was good (according to Sief and our friend Joe), but it was spicy and well...I'm a relatively big baby when it comes to spicy food.

Not sure what I'm going to try today, but I'm sure I'll find something yummy!  The only problem with the TTC is that the hours are only from 10am-6pm - Monday-Saturday.  Makes it a little hard to get their during the week.

P.S.  Penny's a star - a greyhound rescue lady who also takes pictures of dogs came to Tiny Tyrants - Penny's obedience class - see her in all her glory here. 

Happy, content, & comfortable

It's crazy - I've only been in Tucson for less than 2 months and yet I feel more comfortable here than I ever did in Hershey.  Today I was driving in the car when I realized everything felt comfortable.  It was a weird feeling, I haven't had in nearly 4 years.  In Hershey, I always kept looking toward the next step.  Where will I be in 4 years?  I continually imagined myself in various locations - wondering where residency would take me.  I felt like I was missing out on other parts of my life.  That I was stuck in a rut and really not moving forward.  I'm sure residency will have those times as well - that 80 hr work week, doesn't leave much time for other things.

But for the first time in a long while - I'm living more in the moment.  Less worried about where the future is going to take me.  I'm happy right where I'm at.  In 3 years when residency is over, where will I go?  I don't know and to tell you the truth I'm not even really thinking about it.  It's great.

I finally feel like I'm doing what I'm supposed to be doing and I'm in the place where I'm supposed to be doing it.  I'm surrounded by a bunch of wonderful, interesting people, with more things to do than I have time for.
It's good to feel at peace and comfortable in my own skin once again.

P.S.  Soon I'll blog about my ER rotation.

hello, doctor

I'm over halfway done with my first real rotation of residency.  Working in the Emergency Department has been great so far.  It helps a ton that I know a lot of the people in the department through Sief.  

The weirdest part is still the fact that I can write orders for medicines or radiology studies and they will actually happen!  It's what I've been waiting years for.  I finally have my own clinic and am gathering a patient panel.  I'm their doctor.

It's still so weird that nurses (who many know more than me) call me doctor.  Nearly everyday, when I'm wandering about the Emergency Department, either lost because I took a wrong turn, or looking for something - I'll nearly walk right into a nurse or EMT.  They quickly say, "oh sorry doctor."  I want to say, doctor?! what - really, you don't need to say sorry - I'm the one last wandering aimlessly about.

You gotta love the nurses and everyone will tell you, especially when starting out to make friends.  I got to sew up my first laceration in a long time the other day.  My attending sent me out to get the supplies.  I asked the nurse to help me gather them - she asked "what type of suture would you like?"  I looked at her...hmm....good question, I thought.  She answers for me, "how about 5-0 proline."  I smiled and replied, "That sounds good to me."  It worked out just fine.

I also got to put in my first central line the other day, too!  This is similar to an IV, but the catheter (tube) is put in a central vessel.  In my case, we put the catheter in the internal jugular vein.  The procedure was done using ultrasound as a guide.  It was pretty awesome, not for the patient, but for me.  At first, I thought I had lost the procedure, because technically I'd never seen one placed.  I had practiced before with the equipment in a simulation type setting.  Sief was on shift with me then and just recently observed one.  The old adage is "see one, do one, teach one."  When the attending asked if I'd ever seen one I reluctantly replied "no," while looking at Sief thinking he was going to get to do the procedure.  My attending was awesome and said, "well it's your patient and you're going to get your hands dirty."

So, residency has truly begun.  So far so good.  I'm still getting used to being called doctor.  I have not felt the urge to switch over and become an Emergency Medicine doc since being on this rotation.  It's a completely different mindset.  There are so many things I want to treat as a family doctor, but don't need to in the Emergency Department, because it's not an emergency!  It's been fun, but I didn't miss my calling by not joining the ranks of ED docs around the globe.  Glad that their are people to do it though.  I love preventative medicine way too much and continuity of care.  Also, I realized I'm not a fan of the stress or having to think quickly when someone comes in acutely ill - maybe that'll change as I become more competent in my medical skills.

I have a Penny story, but I'll save that for another day!

P.S.  Did you know they have bunnies in the desert?  I didn't!  This is taken right outside my house.

One month down

One month of residency is already down.  Granted it was orientation, which was a great way to get to know some of my fellow residents and get settled into my new home.  Now reality begins.  "Hello - 80hr work week."  Actually I'm pretty lucky in that I start off with 2 relatively light rotations.  For the next 3 weeks I'll be spending my time in the Emergency Department.  It's a great place for me to start, because I know all of Sief's co-residents who are many of the people that I will be working with.

This past weekend, I went to the National Family Medicine Residency Conference in Kansas City that I have gone to for the past 3 years.  This year I was on the other side of things trying to recruit applicants to my program.  It was exciting, because this year there was an increase in the number of students in attendance.  I'm hoping for another big match year for family medicine.  It looks like their may be a shift back to family medicine and maybe away from the specialties?

On my way back from KC, I looked over a tourist guide that Kevin (a co-resident of mine) brought along for students to look at and now I have a huge list of things I plan to do while in Tucson.

- Biosphere 2
-  See the Sonoran Desert
-  Ski Mt. Lemmon (mountain about 45 mins from Tucson that is 8,000+ ft in elevation and at the top it doesn't feel like you're in arizona anymore - I took a drive up there last weekend, but sadly left my camera at home)
- Hot air balloon festival
-  Desert museum
-  Kit Peak Observatory
-  Scavenger Dash around the city
-  golf?  (i threw that in for my parents :)
-  and so much more!

Come visit (well actually wait a little while longer until I have a bed in my spare room, unless you don't mind sleeping on an air mattress) - there's tons to do!

Penny meets cactus

This morning I took Penny for a walk around the block.  7am and already 86 degrees out.  I was sweating by the end and she was panting.  I guess I have to get up earlier to take her for her daily walk.
As we're walking, she travels off the sidewalk a little bit to smell.  No big deal - that's pretty normal.  We continue our walk, again same thing, but...this time I see she is standing on a cactus.  Not a growing cactus but a broken off dead piece of cactus.  There are lots of little dry dead pieces lying on the ground at this point in our walk.  So naturally I tug her leash and say lets go.  Out she hops from the side with a 2-2.5 inch piece of thin (probably 1/2 inch diameter) piece of cactus stuck between her chest and into the pads of her paw.

Great.  How am I supposed to grab this with my bare hands and yank it out.  She's standing there with her leg out because there's essentially a stick pushing her paw away from her chest - we're literally as far from our house on the block as you can get.  I reach down and try to grab the cactus as best I can without getting stuck myself.  I successfully remove the large piece of cactus and there are 2 thorns left in her front paw.  I put Penny under one arm and grab a thorn with my other hand - and yank it out.  I try for the 2nd one.  No success.  Penny's in pain - when I grab and yank she opens her mouth and goes ahhhh.... - like a screaming sound.  She thankfully doesn't try to bite me or swing her open mouth around wildly near my face.
I try on the 2nd thorn again and...nothing.  I pick her up and am about ready to walk her home to wake up Sief (not like he can really help because Penny's afraid of him).
Then I decide to try one last time and I got it!
I set Penny down and she walked the rest of the way home as if nothing happened.  Except she got hot and tired.  I had to walk to get the mail by myself.

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Residency update:  We've continued to have orientation for the past 2 weeks.  I have taken a medical Spanish course which lasted 4 days.  I have spent a little bit of time in the hospital just getting used to the system, etc.  2 half days have been spend in clinic where I actually have my own patients!  I love clinic and all of the nurses have been so wonderful so far!  Also, I've become certified in Advanced Trauma Life Support.  No time to blog, because Sunday was my first day off in 2 weeks!
Welcome to residency - it only gets tougher from here....